NPI 1003007808

Jonathan Rex Gustavson, MSPT

Practitioner Physical Therapist Portland, OR

Practice location

Address: 3426 NE 62nd Ave, Portland, OR 97213-3953
Phone: (503) 312-3443

Registered specialties

Physical Therapist Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 225100000X Licence 4932 (OR)

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Registry record

NPI: 1003007808
Entity type: Individual
Sex (as registered): Male
NPI issued: 6 Aug 2007
Record last updated: 30 Dec 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.